In the role of Referral Coordinator, you will offer inbound and outbound phone support while providing operational processing expertise of clinical referrals using telephony and EMR system(s) while working onsite in a central location within the market. The ideal candidate has experience in a contact center environment and can understand the needs of others to meet those needs with great service and operational processing accuracy. Knowledge of the healthcare industry include reviewing patient charts, insurance and medical billing processes, and EMR/HIN systems preferred but not required. The ability to have premier service interactions without patients is critical to success in this role, in addition to achieving all processing performance objectives.

How you can make a difference

• Processes necessary prior authorizations and insurance referrals as needed to complete the referral process by using payor portal or calling the payor as needed.

• Answers all phone calls in a patient, empathetic, and passionately communicative manner

• Deliver on a commitment to solve problems with patience and understanding, providing knowledgeable and thoughtful service to exceed expectations

• Coordinates medical specialty referral, procedures, and imaging for patients in a timely, efficient, and equitable manner

• Utilizes EMR and HIN system(s) to track, research, and document patient information ensuring accuracy, completeness, and compliance with organizational and HIPAA standards

• Utilizes Authman (Authorization Manager) to execute accurate, timely processing, tracking and management of patient referrals in accordance with organizational standards

• Communicates information, including updates of referral requests, appointment details, and communication preferences via telephone, email, chat, and patient portal

• Review patient charts and records to understand what authorizations and documentations need to be pursued

• Ensure that all barriers to care (such as language, transportation restrictions, or financial needs) are addressed

• Provides clear, thorough, and accurate documentation of all interactions with patients, and other individuals on behalf of patients, in the patient’s electronic health records

• Maintains access to the Health Information Exchange (HIN) and other related systems

• Maintains surveillance ticklers and/or work with Health Information Technology to proactively identify the need for patient care

• Navigates patient to care, as assigned

Skills for success

• A “people-first” attitude and premier customer service DNA

• A genuine excitement to help patients and process referrals with operational excellence

• A problem solver who can confidently troubleshoot and investigate to answer questions or resolve complaints

• Confident with system processing and updates

• Self-motivated: energetic, self-starter; can work autonomously

• Ability to put yourself in patients’ shoes and advocate for them when necessary.

• Results oriented: bias for action; demonstrated track record of achievement; drive for attainment of superior outcomes

• Flexible: ably navigates within ambiguity; solution-oriented communication; conveys thoughts and expresses ideas effectively both verbally and in writing; strong presentation skills

• Collaboration: orientation to team-based work product and results

• Service: Actively supports others, demonstrates an optimistic, can-do approach to issue resolution

• Humility: low ego; engenders trust; respectful

Experience to drive change

• Service center excellence, call center preferred

• Experience in the medical or health insurance field preferred

• Knowledge of medical terminology

• Excellent telephone etiquette

• Skilled in basic computer operations and EMR

• Bilingual in English and Spanish preferred

• Excellent interpersonal skills, including empathy, patience, courtesy, and attentiveness

• Ability to work independently with a strong sense of focus

• Task-oriented, strong organizational skills, ability to multitask

• Strong attention to detail

• High school diploma or GED